A PROSPECTIVE STUDY OF INSULIN RESISTANCE IN GAUCHER DISEASE TYPE 1 PATIENTS WITH NORMAL WEIGHT, UNDER ENZYME REPLACEMENT THERAPY

作者：Zimmermann A^*; Grigorescu Sido P; Rossmann H; Lackner K J; Drugan C; Al Khzouz C; Bucerzan S; Nascu I; Popp R A; Zimmermann T; Weber M M

来源：Acta Endocrinologica-Bucharest, 2015, 11(2): 180-188.

DOI：10.4183/aeb.2015.180

• Gaucher disease
• insulin resistance
• enzymatic replacement therapy

Context. A certain degree of insulin resistance in patients with Gaucher disease type 1 (GD) under enzyme replacement therapy (ERT) was reported. Data on insulin sensitivity in treatment nave patients are inconsistent.
Objective. To analyse prospectively changes in parameters of insulin resistance under ERT and to estimate when they occur.
Design. prospective, controlled study; three years follow-up. Patients and methods. 12 treatment nave patients with GD type 1 (M/W 8/4), 29.5 +/- 12.9 years, without overweight, diagnosed enzymatically and by genotyping, without previous diabetes mellitus.
Patients were evaluated before and every 6 months up to 3 years under ERT and compared at baseline and after 3 years with matched healthy controls. Fasting-glucose (FG), - insulin (FL), C-peptide, HOMA-IR, IRI, HOMA-B, blood count, hepatic and splenic volume, chitotriosidase, severity score index di Rocco (SSI) were assessed.
Results. Baseline glycemic parameters did not differ from controls. FG increased from baseline after two years of ERT (+16.4%,p<0.010), Fl (+40.3%,p=0.030), HOMA-IR (+61.2%,p=0.007) and IRI (+9.1%,p=0.010) after 18 months, HOMA-B after 2.5 years (+51%, p=0.015. After 3 years of ERT patients were more insulin resistant compared to controls (p<0.001): FG (96.0 +/- 6.2 vs. 73.2 +/- 6.4 mg/dL), Fl (11.2 +/- 2.4 vs. 5.6 +/- 1.3 pU/L), HOMA-IR (2.7 +/- 0.6 vs. 1.0+0.3), IRI (3.02 +/- 0.10 vs. 2.62 +/- 0.13). FG, FI, HOMA-IR, IRI, HOMA-B correlated with disease severity markers.
Conclusions. This is the first controlled study which evaluates prospectively insulin resistance in GD patients, finding significant differences compared to baseline starting with 18 months ERT.

• 出版日期2015-6